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Original Investigation | Journal Club

Long-term 3-Dimensional Volume Assessment After Fat Repositioning Lower Blepharoplasty

Timothy R. Miller, MD1
[+] Author Affiliations
1Private practice, Orange County, California
JAMA Facial Plast Surg. 2016;18(2):108-113. doi:10.1001/jamafacial.2015.2184.
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Published online

Importance  First reported 3-dimensional quantitative study of the lower periorbital area after lower blepharoplasty using the fat repositioning technique.

Objective  To determine the volumetric effects lower blepharoplasty with fat repositioning provides to the tear trough and deep fat compartments of the upper cheek.

Design, Setting, and Participants  A retrospective electronic medical chart review (16-month study with a minimum of 10-month postoperative evaluation) was performed on 12 initial patients recruited to a private practice; 2 patients were lost to long-term follow-up. Patients were recruited between May 2014 and November 2014. To fulfill recruitment criteria, patients must have undergone a lower blepharoplasty performed using the fat repositioning technique with a minimum of 10 months follow-up. Patients who had undergone additional procedures or had a history of filler to the tear trough or cheek area before or during the study period were excluded.

Main Outcomes and Measures  Volume (mL) measurement of a defined anatomical area in postoperative patients.

Results  Overall, 10 patients (mean [range] age, 56 [37-66] years) who had undergone a lower blepharoplasty performed using the fat repositioning technique had volume gain in the areas evaluated. The mean (range) follow-up time was 12 (10-16) months. The average volume gain was 0.64 mL (left side, 0.61 mL; right side, 0.67 mL). There was no statistical difference when the 2 sides were compared (P = .49).

Conclusions and Relevance  The fat repositioning technique in lower blepharoplasty improves pseudofat herniation while simultaneously adding volume to the lower periorbital and cheek areas. The results are reproducible with long-term aesthetic improvement in the tear trough and upper cheek areas.

Level of Evidence  4.

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Figure 1.
Results of the Fat Repositioning Lower Blepharoplasty Procedure

A, Preoperative photograph; B, 13-month postoperative result of the fat repositioning lower blepharoplasty procedure.

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Figure 2.
Results of the Fat Repositioning Lower Blepharoplasty Procedure

A, Preoperative photograph of a patient and (B) 12-month postoperative result of the fat repositioning lower blepharoplasty procedure. C, Black line outlining the preoperative facial contour and (D) black line emphasizing the postoperative contour change.

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Figure 3.
Volume Analysis After Fat Repositioning

A, Preoperative photograph of a patient; B, corresponding preoperative untextured 3D image; C, illustrated measured area; D, postoperative photograph with measured area transposed. 3D indicates 3-dimensional.

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Figure 4.
Colorimetric Analysis 12 Months After Fat Repositioning

According to the corresponding scale on the left of the image, blue represents increased volume.

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Figure 5.
Results of the Fat Repositioning Lower Blepharoplasty Procedure

A, Image shows an untextured preoperative 3D image; B, untextured 3D results of the fat repositioning lower blepharoplasty procedure at 12 months. C, Preoperative 2D photograph of the same patient; D, postoperative 2D results at 12 months. E, Black line outlining the preoperative facial contour of the patient; F, black line emphasizing the postoperative contour change. Results illustrate long-term volume augmentation of the tear trough and anterior cheek. 2D indicates 2-dimensional; 3D, 3-dimensional.

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Figure 6.
Results of the Fat Repositioning Lower Blepharoplasty Procedure

A, Preoperative 3-dimensional (3D) image of a patient; B, corresponding untextured image; C, postoperative 3D image at 10 months; D, corresponding untextured image.

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